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C h a p t e r T h r e e Contesting the Medical Marketplace Politics, Publicity, and Scientific Progress, 1869–1910 In 1869, when the Berlin Medical Association proposed a rider to pending trade legislation lifting all barriers to entry into the medical marketplace, medicine became one of the “Free Professions” open to all persons, regardless of gender, confession, age, education, or accreditation .1 Passage of this landmark legislation helped to create an extraordinarily unregulated market for medical care in Germany, one that was unique in the European world.2 At first, doctors saw in the trade act welcome relief from the many duties that, for almost six decades, had come with medical licensing.3 Chief among these was the so-called “compulsion to provide care,” which made the refusal to provide medical services a civil offense.4 In calling for the incorporation of medicine as one of the free professions, the Berlin Medical Association was not knowingly advocating a more competitive medical marketplace: the rider was part of a more cynical effort to free doctors from a variety of professional obligations, including the“compulsion to provide care.”5 The consequences of deregulating medical practice in Germany were not immediately clear.After all, doctors had long worked alongside surgeons , apothecaries, midwives, teachers, priests, and other nonlicensed healers, with different practitioners offering services to different kinds of cure-seekers. This was a medical marketplace governed by informal rules, and as Mary Lindemann, Roy Porter, and others have shown, these rules depended in part on a division of therapeutic labor.6 While the 1869 trade legislation changed the legal framework organizing the • • 64 we lived for the body relationship between licensed doctors and nonlicensed healers, the de facto division of labor did not immediately disappear.7 However, the situation would change dramatically over the next three decades. Changes in the relationships between licensed doctors and “other healers” were conditioned by a range of factors, from the creation of a national insurance scheme beginning in 1883, to an increasingly difficult job market for young doctors.8 The marketplace was also changing in important ways. Beginning in the 1880s, nonlicensed healers increasingly used new media and retail outlets, advocacy groups, associational networks, and other entrepreneurial tactics to broadcast their own therapeutic innovations and create new demand for their services. As nonlicensed healers targeted a more and more diverse audience, as they transgressed the informal rules governing the medical marketplace and encroached upon the traditional client base of licensed doctors, they contributed to a breakdown of the medico-therapeutic division of labor. This process drew doctors, first slowly, then more rapidly, into a competitive relationship with“other healers.” In part because of these new, more competitive dynamics, doctors’ attitudes toward their nonlicensed colleagues underwent a major shift.9 Faced with new and potentially threatening market forces, doctors began to call for the reinstatement of regulatory protections on the professional practice of medicine, and by the late 1890s, German medical associations were actively mobilizing to control the spread of what they called“quackery.” They claimed that swindlers and charlatans were seducing the masses with potions and elixirs, and that uneducated laypeople were dangerously susceptible to promises by unscrupulous fakes. In many cases, medical associations were joined in their crusade by bureaucrats, police superintendents, university professors, and other educated elites, and these defensive alliances are important in understanding the asymmetries that organized the medical landscape. This mobilization of the“official” medical community is an important aspect of the present story. Medical lobbyists tried to marginalize other healers by framing the debate between medical epistemologies in the language of class hierarchies: they tried to convince the public that only the uneducated masses would be foolish enough to prefer“other healers” to university-trained doctors. Historians have done excellent work recov- Contesting the Medical Marketplace 65 ering the rich medical landscapes represented by nonconventional healing traditions, but too often scholarship has taken at face value the Wilhelmine medical lobby’s self-serving map of the medical marketplace. As I show in this chapter, the defensive alliance between medical men and some educated elites is only part of the story. Contrary to what contemporary critics of “quackery” would have us believe, attitudes toward nonlicensed healers did not break down along class lines, nor did an individual’s level of education necessarily dictate his or her perception of a free medical marketplace. It was not, in other words, only “the masses” who were interested in “other” medicine, nor was...


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